Nina Raine’s Tribes, directed by Oonagh Murphy at the Gate Theatre as part of this year’s Dublin Theatre Festival, is an exquisite, fast-paced play centered around members of a family competing with one another to be heard.
Except one family member is deaf from birth. Billy can only piece together parts of what the rest are communicating. As a result, he is more in tune with their moods, and intervenes when he sees his brother Daniel becoming agitated.
Daniel experiences symptoms of psychosis in the form of auditory hallucinations: voices in his head.
Raine’s play – which had its original run at the Royal Court in London in 2010 – is one of several recent works that deal with psychosis in a humane way. Award-winning TV drama Mr. Robot and RTÉ’s documentary The Voices in My Head, have similarly sought to shed light on the complex individuals behind the illness.
In Tribes, Daniel’s deteriorating mental-health conditions are treated with sensitivity and a rare glimpse of what such increasing alienation can look like.
The abusive voices are hinted at the beginning of the play. By the end, Billy’s girlfriend Sylvia offers to interact with the voices, illustrating the belief – one school of thought on the subject – that speaking to voices in your head in a compassionate manner can help to tame them and make them benign, though they may never go away.
This is the approach encouraged by Eleanor Longden, founder of Intervoice, who believes that asking the person hearing the voices, “What happened to you?” rather than “What’s wrong with you?” is a far more effective method for reacting to auditory hallucinations, which can be malicious, derogatory and incredibly distressing (as is apparent by Daniel’s increasing isolation throughout the play).
The portrayal of psychosis in Tribes was sensitive, contextualised and humane. Unfortunately, this is generally not the case.
The overuse of visual stereotypes in films means that the word, “psychosis” can conjure up all sorts of misconceptions and prejudices.
These media portrayals often give an inaccurate picture of what illnesses like schizophrenia involve. This creates such misunderstandings as the idea that schizophrenia means having a split personality, or that psychotic people are dangerous, unpredictable, and often violent.
Psychotic people behave in a frightening manner because they are afraid, Elyn Saks, an academic with a diagnosis of schizophrenia, wrote in her 2008 memoir The Center Cannot Hold: My Journey Through Madness.
It is worth pointing out that Saks attended a psychoanalyst while living in England who allowed her to engage with the voices without judgment or interference. Saks recognised that this was incredibly important for her, and travelled from the United States to visit that therapist when she fell ill.
I have experienced psychosis sporadically throughout my life, and never felt the urge to hurt or behave violently towards anyone. In fact, although I was acting bizarrely, and was therefore frightening to those around me, I recall certain kind gestures with gratitude.
But for me, violent tendencies never came into it. This is not always the case – Kay Redfield Jamison recalls in her brilliant memoir An Unquiet Mind that violent behaviour is something she engages in at the very extremes of her psychosis. However this is the exception, rather than the rule, and occurs when people go off of their treatment plan or medications.
Of course, if someone refuses help, there is not much you can do, except to check in as often as possible and gently encourage the person to see their doctor for help.
I’ve been on anti-psychotic medication for 10 years now, and although I have experienced sporadic breaks from reality, on the whole I am a perfectly functional person.
This is the case with the vast majority of people who experience psychosis. They take medication for it; sometimes the effects wear off and medications have to be changed, but with a good integrated psychiatric-care team, this can all be done in a monitored, measured way, with minimal risk to the patient.
That’s not to underestimate the power psychosis can have over a person’s life. If they don’t take their medication, it can cause major problems, and creates a revolving-door scenario. But it is important not to blame the patient for ceasing to take their prescribed anti-psychotic medication.
For many people, the anti-psychotics cause severe disruptions in their day-to-day lives. Tremors, slurred speech, extreme grogginess – it is no surprise that some eventually get so tired of such symptoms that they decide to take their chances off of the medications.
The side-effects of the medications can themselves frighten people. With time and enough changes, however, the vast majority of people find a balance. There are new ways of taking anti-psychotic medications through injections every few weeks, which make it much easier for people with psychosis to adhere to treatment.
Psychosis, by definition is “a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality”.
So how does this align with the homicidal maniacs of many media portrayals? The word now conjures up hallucinations and voices, yet low mood and feelings of isolation – though they are short on media-friendly dramatics – are often more prominent features of psychosis.
Eroding the stigma around psychosis requires communication, and Murphy communicates through Tribes that mental illness can be part of everyday family life for many people.
Using this as a starting point, the audience get to witness a fascinating dynamic unfold whereby members of the family try and cope with Daniel’s voices.
It is Sylvia, who is losing her hearing throughout the play, who really breaks down the barriers between the worlds with and without voices, by inviting Daniel to engage with them.
In doing so she is corroding the fear and trepidation that the family exhibits when it comes to his auditory hallucinations. There is greater stigma surrounding psychosis than perhaps any other mental-health symptom.
As Sylvia demonstrates, empathy and understanding are crucial if we are to break it down.